Stroke
Stroke (apoplexy) is one of the neurological disorders most commonly seen in Chinese acupuncture clinics. Besides the large number of studies that have been published in China, several studies have been done in the West as well. In one Swedish study, stroke patients receiving acupuncture recovered both faster and to a greater extent than did the control group and had significant differences in improvement of balance, mobility, activities of daily living, quality of life and admission times in hospital/nursing homes (Johansson et al 1993). Other studies have shown significantly greater improvement in acupuncture groups than in control groups (Tidsskr et al 1998, Kjendahl et al 1997, Wong et al 1999, Zhou et al 1997, Chen et al 1990, Pei et al 2001, Li et al 1989). Several Chinese studies have reported that AP treatment of post-stroke aphasia (loss of the ability to use or comprehend language) yields superior results in comparison to control groups.
Mechanisms which may explain spontaneous recovery following a stroke include the resolution of swelling (edema) and the recovery of brain tissue that was injured but not destroyed. Research suggests that acupuncture treatment may help facilitate both of these processes by improving blood circulation to the brain. In examining stroke patients before and after undergoing acupuncture treatment, Chinese researchers have observed positive changes in several different physiological indicators. These include EEG, hemorheology, and blood serum levels of lipoproteins. Acupuncture treatment has been found to improve blood circulation to the brain and increase the partial pressure of oxygen and the supply of nutrients to undestroyed brain cells surrounding the area damaged by a stroke. Depressed stroke victims are less likely to recover, and any enhancing effects of acupuncture on mental well-being should be considered, in addition to acupuncture’s effects on blood flow to the brain.
Whereas studies from China and Japan heavily support a role for acupuncture treatment in thousands of cases of stroke, Western studies are often equivocal. Why is this so? First, the acupuncture approach is different. In the Orient, acupuncture is done daily to twice daily for maximum stimulation of the nervous system. Various experts recommend treating 3 times weekly as a minimum; more would be better. Second, Western studies use standard points on the arms and legs. Chinese studies indicate that using scalp points alone or in addition to provide a stronger input. A newer approach, Xingnao Kaiqiao (“consciousness awakening"), generated by Dr. Shi Xuemen and co workers (Shi et al 1989), appears extremely attractive. They treat a number of traditional points on the body in sequence each to the point of muscle jerking. In a series of 3200 patients, an essential cure is claimed in 58% and 90% effective improvement to the point of reasonable self sufficiency.
Johansson B B 1993 Has sensory stimulation a role in stroke rehabilitation? Scandinavian Journal of Rehabilitation. RESULTS: “Patients receiving acupuncture recovered faster and to a greater degree than those in the control group. There was a significant between-group difference in balance, mobility, activities of daily living on Barthel's Index, quality of life on the Nottingham Health Profile, and number of days spent in hospitals or nursing homes.” CONCLUSIONS: “Treatment with acupuncture in patients with stroke who have severe impairment can achieve functional outcomes better than those achieved with contemporary physiotherapy.”
Ou,Y.W., Han,L., Da,C.D., Huang, Y.L., Cheng, Y.S. Influence of acupuncture upon expressing levels of basic fibroblast growth factor in rat brain following focal cerebral ischemia - evaluated by time-resolved fluorescence immunoassay. Neurol Res Vol.23(1) p.47-50. 2001. RESULTS: “Electroacupuncture (EA) alleviated the infarction and swelling induced by the ischemia, and markedly enhanced the opening amount of the micrangium. There also appeared to be a slight increase in cortical total protein in the EA group. EA substantially up regulated the level of basic fibroblastic growth factor (bFGF), especially in the frontoparietal cortex (but also the striatum), as compared to the ischemia alone group of rats.” AUTHOR'S CONCLUSIONS: “Laboratory support exists for a potential neuroprotective mechanism of EA via endogenous bFGF expression, providing the possibility of combining the use of acupuncture and bFGF in the treatment of acute cerebral ischemic injury.”
Tidsskr Nor Laegeforen 1998 Mar 30;118(9):1362-6 Acupuncture in stroke. Kjendahl A, Sallstrom S, Osten PE, Stanghelle JK, Borchgrevink CF.Sunnaas sykehus, Nesoddtangen. CONCLUSIONS: “The results show that there was a significantly greater improvement in the acupuncture group than in the control group, both during the six- week treatment period, and even more so during the following year. These assessments were based on the Motor Assessment Scale, the Sunnaas Index of Daily Living (ADL), the Nottingham Health Profile and the patients' social circumstances.”
Kjendahl A, Sallstrom S, Osten PE, Stanghelle JK, Borchgrevink CF. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study. Clin Rehabil 1997 Aug;11(3):192-200. RESULTS: The results show that the acupuncture group improved significantly more than the controls, both during the treatment period of six weeks, and even more during the following year, both according to MAS, ADL, NHP and the social situation. CONCLUSION: Although the mechanism of the effects is debatable, there seems to be a positive long-term effect of acupuncture given in the subacute stage post stroke.
Wong AM, Su TY, Tang FT, Cheng PT, Liaw MY 1999. Clinical trial of electrical acupuncture on hemiplegic stroke patients. Am J Phys Med Rehabil 1999 Mar-Apr;78(2):117-22. RESULTS: “Patients treated with electrical acupuncture had a shorter duration of hospital stay for rehabilitation and better neurological and functional outcomes than the control group had, with a significant difference in scores for self-care and locomotion (P = 0.02).”
Zhou J, Zhang F. A research on scalp acupuncture for cerebral infarction. J Tradit Chin Med 1997 Sep;17(3):194-7. CONCLUSIONS: “After treatment, such symptoms as hemiplegia, lingual dysfunction, facial and tongue paralysis, and the laboratory indexes of blood fat, fibrinogen and hemorrheology were obviously improved (P < 0.01 or 0.05). The therapeutic effect of scalp acupuncture was obviously better than that of Western medicine (P < 0.01).”
Chen DZ. Evaluation of therapeutic effects of acupuncture in treating ischemic cerebrovascular disease. Zhong Xi Yi Jie He Za Zhi 1990 Sep;10(9):526-8, 515. RESULTS: “After treatment the results were as follows: the marks of functional nervous damage in the test group were reduced 13.0 average, but only 3.75 in the control group. There was a very remarkable difference between these two groups (P less than 0.001). Slow wave of the EEG-map in the test group were reduced 1.70 level average, but only 0.05 in the control group (P less than 0.001). theta wave of the EEG-map in the test group were reduced 1.05 level average, but only 0.25 level in the control group (P less than 0.001). The diversity of latent period of P45 peak wave value between left limbs and right limbs were reduced evidently in the test group and showed a very significant statistical difference. (P less than 0.05) as compared with the control group.”
Pei J, Sun L, Chen R, Zhu T, Qian Y, Yuan D. The effect of electro-acupuncture on motor function recovery in patients with acute cerebral infarction: a randomly controlled trial. J Tradit Chin Med 2001 Dec;21(4):270-2. Randomized 86 patients into acupuncture and non-acupuncture groups. CONCLUSION: “Early acupuncture treatment for acute stroke patients may improve motor functions, and consequently the activities of daily living.”
Shi et al 1989. Clinical research on 50 cases of stable stage apoplexy treated by acupuncture using brain activating and consciousness regaining principles. Zhong Xi Yi Jie He Za Zhi 1989 Nov;9(11):653-5, 643-4 . CONCLUSIONS: “The experimental research also indicated that this therapeutic method could improve blood rheology, microcirculation, increase the content of HDL and resist thrombosis. Thus, it could promote the injured cerebral cells to be recovered.”
Zhai N, Lu X, Shi X, Xu P. 1993. Morphological study on acupuncture in interfering experimental cerebral infarction in rats. II. Change of ischemic area in cerebral interior. Zhen Ci Yan Jiu 1993;18(3):209-12. RESULTS: “Whereas the ischemic area in the cortex disappeared in the acupuncture group, the ischemic volume reduced to 6.3 percent of the whole. The experiment pointed out that the acupuncture is an effective therapeutic procedure for cerebral infarction.”
Yu YH, Wang HC, Wang ZJ. The effect of acupuncture on spinal motor neuron excitability in stroke patients. Zhonghua Yi Xue Za Zhi (Taipei) 1995 Oct;56(4):258-63. CONCLUSIONS: “This result provides positive evidence of increased spinal motor neuron excitability in paretic limbs of stroke patients and also of the acupuncture effect which decreased that excitability.”
Yuan X, Hao X, Lai Z, Zhao H, Liu W. Effects of acupuncture at fengchi point (GB 20) on cerebral blood flow. J Tradit Chin Med 1998 Jun;18(2):102-5. RESULTS: “Blood velocity in the vertebral artery and the basilar artery was observed before and after acupuncture at Fengchi point (GB 20) in 97 patients by transcranial Doppler ultrasonic detecting. The results showed that the blood velocity in patients with either high or low blood flow had significant changes after acupuncture (P < 0.001).”
Li J. Forty-five cases of apoplexy treated by electroacupuncture at the points of yin meridians. J Tradit Chin Med 2001 Mar;21(1):20-2.
Lee JD, Chon JS, Jeong HK, Kim HJ, Yun M, Kim DY, Kim DI, Park CI, Yoo HS. The cerebrovascular response to traditional acupuncture after stroke. Neuroradiology 2003 Aug 27;. "We obtained single-photon emission computed tomography (SPECT) brain perfusion images of six patients with middle cerebral artery occlusion obtained before and after acupuncture and compared the changes in regional cerebral blood flow (rCBF) to those in normal control. Images were obtained before and after acupuncture at six traditional acupoints (LI 4, 10, 11, 15 and 16 and TE5) in the affected arm. The baseline image was subtracted from the postacupuncture image, to produce a subtraction image displaying only voxels with values >2 SD from the mean and those voxels were coregistered to the baseline SPECT or T2-weighted MRI. Similar images were obtained before and after acupuncture of eight normal volunteers. Statistical parametric mapping with a threshold of P =0.001 and a corrected P of 0.05 was performed for group comparison between postacupuncture and baseline SPECT. Focally increased CBF was seen in all patients especially in the hypoperfused zone surrounding the ischaemic lesion, the ipsilateral or contralateral sensorimotor area, or both. Normal subjects showed increased rCBF mainly in the parahippocampal gyrus, premotor area, frontal and temporal areas bilaterally and ipsilateral globus pallidus. Acupuncture stimulation after stroke patients appears to activate perilesional or use-dependent reorganised sites and might be a way of looking at brain reorganisation."
Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, Cho KH Antispastic effect of electroacupuncture and moxibustion in stroke patients. Am J Chin Med 2003;31(3):467-74. "Spasticity is a frequently observed motor impairment that develops after stroke. The objective of this study was to evaluate the efficacy of electroacupuncture (EA) and moxibustion (Mox) on spasticity due to stroke. The subjects consisted of 35 stroke patients with elbow spasticity whose mean duration of stroke was 2.97 months. Fifteen patients were randomized to the EA group, ten to Mox, and ten to control. Every other day, 30 minutes of electrical stimulation with a frequency of 50 Hz was given through four needles on the Ch'u-Ch'ih-San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the paretic side. Direct Mox was applied to Ch'u-Ch'ih (LI-11), San-Li (LI-10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points three times a day every other day. The control group was given only the routine acupuncture therapy for stroke and range of motion (ROM) exercise, which were also applied to the EA and Mox groups. The efficacy of treatment was measured before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15 days after the start of treatment using a modified Ashworth scale (MAS). In the EA group, spasticity was significantly reduced immediately, 1 hour and 3 hours after treatment (p < 0.05). Reductions were significant on the 5th day and thereafter (p < 0.05). In the Mox group, there was no significant change in the MAS scores after the first treatment. In the Mox and control group, there was no significant change in MAS scores. This study suggests that EA can temporarily reduce spasticity due to stroke, and if applied repeatedly it can maintain reduced spasticity.
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