by Wei Yuxiang, Lu Shenglu and Wang Xingwu
　　(Gansu Rehabilitation, Lanzhou 73000, China)

Abstract This study is designed to observe the therapeutic effect of penetrating needling Sishencong (EX-HN 1) through to Baihui (GV 20), etc.. A total of 100 cases of infantile cerebral palsy were divided into acupuncture group (n = 50) and control group (n = 50, oral administration of cerebrolysin). After 3-4 courses of treatment, results showed that the total effective rates of acupuncture group and control group were 84.0% and 48.0 % respectively. Comparison between two groups in the effective rate showed a significant difference (P< 0.05), suggesting that the therapeutic effect of acupuncture stimulation is superior to that of western medicine in treatment of child cerebral palsy.

Key Words Child cerebral palsy Acupuncture therapy Sishencong through to Baihui

Child cerebral palsy (CCP) is a non-progressive cerebral injury-induced syndrome occurring within a month from pre-birth to postbirth, manifested mainly by central neurogenic dyskinesia and abnormal posture, disturbance of vision, audition, speech and intelligence, and epileptic attack. It seriously endangers children's mental and physical health and often results in permanent disability. Up to now, there have not yet been any special therapeutic approaches. In recent years, the authors adopted penetration needling and moxibustion to treat CCP and achieved satisfactory results.

General Data
　　1. All 100 cases of CCP corresponded with the Standards for Diagnosis and Typing formulated by the National Conference of Cerebral Palsy in July of 1987. Among them, 56 were male and 44 female, ranging in age from 6 months to 14 years. The longest duration of disease was 14 years and the shortest 6 months. The longest duration of treatment was 10 months and the shortest 3 months. CT examination displayed that 26 cases had not any marked abnormal changes and 74 cases had clear pathologic changes including 17 cases of cerebral white matter malacia, 19 cases of cerebral atrophy, 21 cases of enlargement of the brain ventricle, 2 cases of disturbance of myelinogeny, 10 cases of porencephaly and defect of trabs, 4 cases of hydrocephalus and 1 case of cerebral hemorrhage.
　　2. Typing of Cerebral Palsy.
　　If the limbs were limited in movement, with the motor ability being 50-59 points (i.e., the myodynamia was below IV grades), it was considered as mild palsy; if the motor ability was 36-49 points (the myodynamia was III), it was considered as moderate palsy; when the motor ability was 20-35 points (myodynamiawas I-II+), it was considered as severe palsy: and when the motor ability was 0-19 points (the myodynamia was 0-I), it was considered as extremely severe palsy.
　　3. Typing of Hypophrenia
　　If being 50 -- 59 points in the intelligence, it was considered as mild palsy, if being 36 �?9 points, it was considered as moderate palsy and if being 20-35 points, it was considered as serious palsy.

Methods
　　1. Acupuncture Group
　　According to the different state of disease, chose different needling depth and stimulating strength. In treatment palsy children with hypophrenia and salivation, a filiform needle was inserted into front Shencong with the needle tip being toward the face part, and those inserted in other three Shencong with the needles penetrated from Shencong to Baihui (GV 20). For palsy of the lower limbs, 4 needles were inserted into Sishencong (EX-HN 1) respectively, with the needle tips toward the back part of the head and about 1 cun in depth. For strabismus, the needles were inserted into the four acupoints to a depth of about 0.5-1.0 cun, generally 1.0 cun, and manipulated with uniform reducing and reinforcing method.
　　Adjunct acupoints: 1). Guangming (GB 37) was supplemented for strabismus; Chengjiang (CV 24) added for salivation; and Yamen (GV15) added for slurred speech; 2). For serious dyskinesia of the upper limbs, flexion of the forearms with disturbance of supine movement, adduction of the thumb and other four chick-claw-like fingers with dysfunction in adduction and stretching, Quchi ((LI 11), Shousanli (LI10), Houxi (SI 3), Hegu (LI 4) and Neiguan (PC 6) were taken respectively along the axillary nerve, musculo-cutaneous nerve, median nerve, ulnar nerve, radial nerve and according to Large Intestine Meridian of Hand Yangming, Small Intestine Meridian of Hand Taiyang and Sanjiao Meridian of Hand Shaoyang ; 3). For adductor spasm of the lower limb, disturbance of the knee in flexion and stretching, scissors-like legs with the toes touching down the ground, Yanglingquan (GB 34), Zusanli (ST 36 ), Juegu (GB 39 ), Zhongfeng (LR 4), Taixi (KI 3) and Taichong (LR 3) were taken along the femoral nerve, obturator nerve, sciatic nerve, common peroneal nerve, and tibial nerve, and according to Liver Meridian of Foot-Jueyin, Spleen Meridian of Foot Taiyin, Kidney Meridian of Foot Shaoyin, Stomach Meridian of Foot Yangming and Gallbladder Meridian of Foot Shaoyang. These acupoints were needled, once every day, with the needles being retained generally for 30 min and in combination with moxibustion of Qihai (CV 6), Yaoyangguan(GV 3 ), Shenshu' (BL 23 ) and Shenzhu (GV12). Thirty days formed a therapeutic course and the interval between two courses was 10 days. Generally, these patients were treated continuously for 4 courses.
　　2. Control Group
　　The control group was made up of 50 cases. They were treated with intravenous drip of normal saline, with Cerebrolysin 5-0 ml, 10 days being a therapeutic course. 3-4 courses were conducted continuously.

Standards for Evaluating the Therapeutic Effect

Cured: Clinical symptoms and signs disappeared basically, and the patients could take care of themselves in daily life. Markedly effective: Clinical symptoms and signs improved strikingly, the patient could hold something with hands, stood and walk. Effective: Clinical symptoms and signs improved but myodynamia of the four limbs had no significant improvement and the patient could not walk. Ineffective: After 3 �?4 courses of treatment, clinical symptoms had no any significant changes.

Results

Table 1. Typing of Cerebral Palsy and the Therapeutic Effect of the Acupuncture Group

Typing Cases Cured Markedly effective Effective Ineffective Total effective rate

Spasm 19 3 9 7 0 100
　　Mixture 14 2 5 3 4 71.4
　　Athetosis 10 0 5 3 2 80.0
　　Athelen-cephalia 7 0 3 2 2 71.4
　　Total 50 5 22 15 8 84.0
　　

　　Table 2. Typing and the Therapeutic Effect of the Control Group

Typing Cases Cured Markedly effective Effective Ineffective Total effective rate

Spasm 19 0 4 5 10 47.4
　　Mixture 15 0 3 4 8 46.7
　　Athetosis 10 0 2 3 5 50.0
　　Athelen-cephalia 6 o 2 1 3 50.0
　　Total 50 0 11 13 26 48.0

　　From Table 1, it can be seen that, the therapeutic effect of acupuncture for spasm type of cerebral palsy is the best while that for atelencephalia is poorer and the total effective rate is 84%; in control group, the therapeutic effect for spasm type and mixture type is poorer and the total effective rate is 48%. Comparison between two groups in the therapeutic effect showed X2 = 14. 44, P < 0. 05, meaning that the effect of acupuncture is significantly superior to that of cerebrolysin in treatment of cerebral palsy.

A Typical Case

Xue, a boy of two and a half years old, visited our hospital on May 21st, 1996. His mother complained that when she gave birth to her child, due to difficult labor, this child experienced severe asphyxia for 10 min. Through emergency treatment, he was out of danger. When he was six months old his parents found their baby being abnormal in behavior, and it was diagnosed as cerebral palsy. Examination showed that the baby had a poor reaction, slurred speech (only could speak a single word),salivation, inability to sit, his head being unable to control, severe dyskinesia of the left arm, his upper arm being unable to lift externally and horizontally, his forearm being unable to make flexion and supine movement, his wrist presenting flexion and abduction, adduction of the thumb and the other fingers being chick-claw-like; his left arm being grade 11 and right arm being grade IV in myodynamia, weak waist and his pelvis being poor in stability. When he stood up with help, his legs were scissors-like with the tips of toes touching down the floor. The myodynamia of his two legs was grade II, the Babinski's reflex was positive with a hyper-reflex of the knee, CT examination showed cerebral atrophy and enlargement of the brain ventricle. It was disgnosed as spasmodic cerebral palsy. Differentiation of syndromes of TCM: Yin-deficiency of both liver and kidney and malnutrition of the brain. Therapeutic principles: tonifying the kidney, strengthening the brain and promoting production of brain marrow. He was treated by using penetration needling from Sishencong (EX-HN 1) through Baihui (GV 20), Yamen (GV 15), Chengjiang (CV 24), Taixi (KI 3, stimulated with reinforcing manipulation), Taicong (LR 3, stimulated with reducing manipulation), in combination with moxibustion at Qihai (CV 6), Quchi (LI 11 ), Houxi (SI 3),Yaoyangguan (GV 3), Shenshu (BL 23 ) and Shenzhu (GV 12). After two courses of treatment, his symptoms bettered obviously, including improvement of head control and restricted movement of the left upper limb and cease of salivation, he could hold things on his own initiative. After 4 courses of treatment, his scissors-like legs ameliorated and after 6 courses of treatment, he could get down from bed and walk forward more than 10 steps. Cerebral CT examination had not any positive signs.

Discussion

1) Sishencong (EX-HN 1) belongs to extra-ordinary acupoints located at the central crossing points of the vertex, the front and the back points are located on the track of Dumai (Du meridian) and the left and right points are near the track of Bladder Meridian. Combination of Baihui (GV20) and other acupoints of the three Yang meridians of the foot can function in dredging and regulating all Yang-Qi of the body.
2). CCP is attributed to the category of flaccidity syndrome in traditional Chinese medicine. It often results from congenital defect, or deficiency of the liver, spleen and kidney and blockage of blood stasis in the interior of the body. The focus is located in the brain. In the light of the theory of traditional Chinese medicine, the brain is the convergence place of Qi and blood of Zang and Fu organs and meridians which are closely interrelated in physiological activities and affected each other in pathological changes. In this study, penetration needling of Sishencon (EX-HN 1) through Baihui (GV 20) was used for replenishing essence and brain marrow, nourishing the kidney and liver, dredging meridians, promoting circulation of Qi and blood, improving blood supply of the cerebral tissue, thus, clinical symptoms and signs were ameliorated clearly.