A Comparative Observation on Comprehensive Scalp-Acupuncture Treatment of Ischemic Apoplectic Hemiplegia

　　By RenYanhong 
(Affiliated Hospital of Beijing College of Acupuncture 
and Orthopaedics, Beijing 100015)
　　 Instructors: Wang Dai and Feng Chunxiang 
(Beijing College of Acupuncture and Orthopaedics )

Scalp acupuncture with comprehensive manipulations of lifting, thrusting, moving, and retaining is a unique acupuncture therapy frequently used by Prof. Wang Dai and Prof. Feng Chunxiang to treat apoplectic hemiplegia. The author treated l00 cases of hemiplegia due to ischemic apoplexy with the above method from l992 to l996, and obtained satisfactory therapeutic results as reported in the following.

Clinical Data
All the l00 cases in this study were inpatients from the Department of Neurointernal Medicine, General Hospital of Beijing Military Command of People's Liberation Army. All the cases were out of danger and with a stable condition of illness. Among them, 57 were male and 43 female, ranging in age from 46 to 79 years. The shortest duration of disease was l5 days and the longest 3 months. In this series, all the patients were definitely diagnosed by craniocerebral computerized tomography. 86 cases were cerebral thrombosis, 4 cerebral embolism, and 10 lacunar cerebral infarction. Primary apoplexy was found in 87 cases and secondary apoplexy in l3 cases. 33 cases were in mild condition at the first visit and 67 cases severe. 46 cases had a history of hypertension, 24 coronary heart disease, 46 cases with hyperlipemia, and 87 cases hyperviscosemia.
The patients were randomly divided into three groups. 30 cases in Group A were treated with western drugs alone; 30 cases in Group B with western drugs and scalp acupuncture by quick twisting manipulation; and 40 cases in Group C by scalp acupuncture with comprehensive manipulations of lifting, thrusting, moving, and retaining.

Method of Treatment
Group A: 500 mg of low molecular dextran and 500 mg of cytidine diphosphate choline in 100 ml of 5% glucose were intravenously dripped once daily.
Group B: Scalp acupuncture was performed once daily in addition to the treatment with western drugs identical as that for Group A. Selection of points and needle insertion were the same as those in Group C. Dr Jiao Shunfa's quick twisting manipulative method was adopted. After the needles were inserted to the subgaleal space, quick twisting manipulation at a frequency of 200/min was carried out for 3 minutes till the patient felt scalp heaviness, numbness, fullness, and heat. The needles were withdrawn after the same manipulation was given 3 times.
Group C: The western drugs used were the same as that used in Group A. In scalp acupuncture, middle line of vertex, vertex-temporal anterior oblique line, and middle line of forehead were selected as the treatment lines.
Middle line of vertex (Qianding DU 21 to Baihui DU 20): After routine sterilization, a NO.32 l.5-cun filiform needle was swiftly inserted obliquely to subgaleal space at an angle of 300 from Qianding (DU 2l) towards Baihui (DU 20), and then the needle was horizontally pushed forward towards Baihui (DU 20) for l.2-cun. Manipulation by heavy and rapid lifting and heavy and slow thrusting at an amplitude of 0.3-cun and a frequency of l00/min was performed for 3 minutes to make the needle body contact and rub the periosteum to the maximum until the patient felt scalp heaviness, tenseness, numbness, fullness, and heat. Then, massage and passive moving of the affected limb were done for three minutes. After the above procedures were repeated 3 times, the needle was retained for 24 hours, during which the patient was asked to do active or passive movement of the affected limb.
Vertex-temporal anterior oblique line (Qianding DU 2l to Xuan1i GB 6): vertex-temporal anterior oblique line on the opposite side of the affected limb was selected as the treatment line. After routine sterilization, three No.32 l.5-cun filiform needles were penetratingly inserted with 3-section-relayed needling method from Qianding (DU 2l) towards Xuanli (GB 6) with the needle bodies reaching the subgalea. The manipulation was the same as that used in middle line of vertex.
Middle line of forehead: After routine sterilization, a No.32 l—cun filiform needle was inserted to the subgaleal space from Shenting (DU 24) with the same manipulation as mentioned above. Scalp acupuncture was given once every other day.
For all the 3 groups , l0 sections of treatment constituted one therapeutic course
with a 3--day interval between courses. After 3 courses of treatment, the therapeutic effects were evaluated.

Therapeutic Effects
In this series, the therapeutic effects were evaluated according to The Criteria for Diagnosis and Therapeutic Effect Evaluation of Apoplexy in Traditional Chinese Medicine formulated on June, 1986 in Tai'an by the Internal Medicine Branch of the China Association of Traditional Chinese Medicine and the Cooperative Research Group on Apoplexy in Traditional Chinese Medicine Emergency, Health Ministry of P.R.C.
l. The therapeutic effects in the three groups were shown in the Table 1.

Table 1. Comparison of the Therapeutic Effects in the Three Groups 
 

As shown in Tab1e 1, the therapeutic effects in Group B and Group C were superior to that of Group A. Difference in the therapeutic effects between Group B and Group A was not statistically significant (P>0.05), but the difference between Group C and Group A was statistically significant (P>0.05).
2. Comparison of myodynamia between the three groups before and after treatment was shown in Table 2.
As shown in Table 2, before treatment myodynamia in the three groups was basically
similar and the difference was not statistically significant (P>0.05). After treatment, the increase of myodynamia of the upper and lower limbs in Group C was significantly superior to that of Group A (P0.05). As compared with Group B, the increase of myodynamia of the upper and lower limbs in Group C was relatively better, but the difference was not statistically significant (P>0.05).
3. The relationship between the therapeutic effect and the infarct size in Group C was analyzed. The cerebral infarct size in 40 cases was classified in the light of the result of craniocerebral computerized tomography Low density region of craniocerebral computerized tomography greater than 4 cm in diameter was called large infarction; low density less than 2cm in diameter small infarction; low density 2 to 4 cm in diameter, middle infarction. Table 3 shows the relationship between the therapeutic effect and the infarct size in Group C.

Table 2. Comparison of Myodynamia among the 
Three Groups Before and After Treatment
　　

　　 
Table 3. The Relationship Between the Therapeutic 
Effect and the Size of Infarct in Group C

4. Relationship between the depth of infarct site and the therapeutic effect in Group C was analyzed, in which the infarct focus localized in the cerebral cortex was called superficial infarction, and the infarct involving the white matter around the internal capsule, thalamus, basal ganglion, and ventricles of brain was called deep infarction. Relationship between the depth of infarct site and the therapeutic effects in Group C can be seen in Table 4.

Table 4. Relationship between the Site of Infarct 
and the Therapeutic effects in Group C

As shown in table 4, the difference in the therapeutic effect between deep and superficial infarct sites was statistically significant (P<0.05), indicating that the therapeutic effect of the acupuncture for superficial infarction localized in the cerebral cortex was more satisfactory than that of deep infarction.

Discussion
From the above-mentioned results, it can be concluded that the scalp-acupuncture with comprehensive manipulations of lifting, thrusting, moving, and retaining exerts a satisfactory therapeutic effect in treating ischemic apoplexy with a faster increase in myodynamia and an improvement in the patient's life quality. In “Correct Application of Various Kinds of Needles�?of Miraculous Pivot, it is stated that for treating the rheumatism involving the bone, the needle should be inserted to the bone, so that the needle body can rub the periosteum by lifting and thrusting. Under the enlightenment of the theory the author's instructors searched out scalp-acupuncture with the comprehensive manipulations of lifting, thrusting, moving, and retaining for treatment of ischemic apoplexy. It is found that the therapeutic method may also exert a satisfactory therapeutic effect for treatment of hemorrhagic apoplexy.

In addition, we also observed the changes in various hemorheological indexes in the patients of Groups A, B, and C before and after treatment. It was found that the hematocrit, platelet aggregation rate, fibrinogen, whole b1ood viscosity and plasma viscosity in patients of the three groups obviously decreased after treatment. Comparison among the 3 groups revealed that the decreases in Group B and Group C were more obvious than that in Group A. However, there was no significant difference in the decreases in various hemorheological indexes between Group B and Group C, suggesting that scalp-acupuncture may decrease blood viscosity to increase cerebral blood flow and facilitate the establishment of cerebral collateral circulation.