by Li Yanhui， Jiang Ganghui， Pan Wenyu，(Dept. of Acupuncture and Moxibustion, First Affiliated Hospital of 

Guangzhou University of TCM and Pharmacology, Guangzhou 510405, China)

Abstract : In the present paper, 61 cases of ischemic cerebral apoplexy were randomly divided into enclosing needling group (n=31) and scalp-acupuncture group (n=30). After 30 sessions of treatment, there was a significant difference between the two groups in the therapeutic effect (P<0.05), indicating enclosing needling being superior to scalp-acupuncture. Both enclosing needling and scalp-acupuncture could lower plasma NO content while the former was more apparent in lowering plasma NO level.

 Key Words Ischemic cerebral apoplexy  Enclosing needling  Scalp-acupuncture  Plasma NO

Stroke is a common disease occurring in the middle-aged and old people and is of higher death rate and disable rate. Many studies demonstrated that acupuncture is quite effective in treatment of cerebral apoplexy. In order to searching more effective therapies, in the present paper, comparison of the therapeutic effect between enclosing needling and scalp-acupuncture was made in 61 cases of ischemic cerebral apoplexy patients.

 Clinical Data

According to “Criteria for Diagnosis of Apoplexy and Evaluation of the Therapeutic Effect" formulated by the Cerebral Disease and Emergency Cooperation Group of Chinese State Administration of Traditional Chinese Medicine in 1996[1], 61 cases of ischemic stroke patients confirmed to have cerebral infarction focus by CT or MRI examination were subjected into this study. Among them, 39 cases were male and 27 female. All the patients were inpatients and were randomly divided into CT-orientation enclosing needling group (enclosing needling group, in shor t, n=31) and scalp-acupuncture group (n=30). Their average duration of disease and average age were 12.23±6.36 days and 60.66±5.91 years respectively in enclosing needling group; and 13.47±6.81 days and 61.38±4.68 years respectively in scalp-acupuncture group. There were no any significant differences between the two groups in the sex, age and duration of disease (P>0.05).

 Treatment Methods

Enclosing needling group: The punctured spots were within the peripheral scalp zone around the focus-projecting location shown by CT scanning. Gauge-28 or 30 filiform needles were inserted into the subcutaneous tissues one by one, with an angle of about 30 degrees between the needle body and the scalp and the needle tips being controlled to advance towards the center of the focus. The interval between two needles was about 2 cm. After achieving needling sensations (numbness and distention feeling in the local area), the needles were twirled rapidly  at a frequency of 180-200 times/min for 2 min. The needles were retained for 30 min and manipulated once again about every 5 min. Adjunct acupoints: Hegu (LI 4), Taichong (LR 3) and Taixi (KI 3) were supplemented for hyperactivity of the liver-yang; Fenglong (ST 40) and Xuehai (SP 10) supplemented for blockage of meridian collaterals by accumulation of phlegm; Quchi (LI 11) and Fenglong (ST 40) supplemented for up-stirring of phlegm-heat; Zusanli (ST 36) and Sanyinjiao (SP 6) supplemented for qi-deficiency and blood stasis; Taixi (KI 3) and Taichong ( LR 3) supplemented for wind-stirring due to yin-deficiency; and Yamen (GV 15) and Lianquan (CV 23) supplemented for slurred speech. The needles were manipulated with reinforcing method for deficiency-type stroke and with reducing method for excess-type stroke.

Scalp-acupuncture group: The Motor Area (MS 6) and Sensory Area (MS 7) on the opposite side of the hemiplegia were punctured. The needle insertion angle, two needles' distance, needling manipulations and adjunct acupoints were the same to those of enclosing needling group. Patients of both groups were treated once daily and 30 sessions were made up of one therapeutic course. In case of persistent hypertension, the patients were asked to take Nifepine, etc. Plasma nitric oxide (NO) contents were determined using enzyme labeling method. NO kit was supplied by Shenzhen Jingmei Bio-engineering Limited Company.

 Observation on the Therapeutic Effect 

In the light of “Criteria for Diagnosis of Apoplexy and Evaluation of the Therapeutic Effect" changes of symptoms of mental activity, speech, limb movement function and others were evaluated by giving marks. The therapeutic effect was judged by using the formula; (marks of pre-treatment-marks of post-treatment)/marks of pretreatment ×100%. Basically cured: After treatment, symptoms and signs decreased by 1%, below 6 marks; Markedly effective: 6% and <8 1%; Effective: 1% and <56%; Ineffective: <11% or the state of disease worsened.

 Result

1. Ridit analysis of the results showed a significant difference between enclosing needling group and scalp-acupuncture group in the therapeutic effect (P<0. 05), suggesting enclosing needling being superior to scalp-acupuncture (Table 1 ).

Table 1. Comparison of the Therapeutic Effects between 

Enclosing Needling Group and Scalp-acupuncture

2. Changes of plasma NO

Comparison of plasma NO contents between healthy people (15 cases, 52.32±10 .61 μmol/L) and stroke patients (40 cases, 87.92±16.58 μmol/L) showed a significant difference (P<0.01). It indicated that plasma NO level in stroke patients was significantly higher than that of normal people. After treatment, the plasma NO contents of both enclosing needling and scalp-acupuncture groups lower ed considerably in comparison with pre-acupuncture (P< 0.01, Table 2).

Table 2. Comparison of Plasma NO Contents (μmol/L, M±SD) 

between Pre- and Post-Treatment of Enclosing Needling 

and Scalp-Acupuncture Groups

The average difference value of plasma NO between pre-and post-treatment in enclosing needling group (25.34±17.95 μmol/L ) was significantly higher than that of scalp-acupuncture group (14.57±11.36) (P<0.01), suggesting a more significant effect of enclosing needling on plasma NO level.

Discussion

The point selection in CT-orientation enclosing needling group was based on the combination principle of local and distal acupoints, with the principal stimulating site being on the scalp. The head is the convergence place of all yang meridians of the whole body. Acupuncture stimulation can promote circulation of blood and qi and dredge meridians. Thus, patients' symptoms and signs could be improved significantly.

NO is a non-typical information molecule and has a wide range of physiological functions. It is a gas substance functioning as an inter-cellular massager an d also has a toxic effect on cells��?-3��? During cerebral ischemia, NO also has both potential beneficial and noxious effects including maintaining blood flow volume of the brain and suppressing platelet or leukocyte aggregation and adhesiveness in one aspect and enlarging ischemic focus and aggravating cerebral edema on the other aspect. It was reported recently that within the first sever al hours of occurrence of ischemia, NO had a beneficial effect on cerebral cells and then generated a neurotoxic action��?��? In the present study, result s indicated that plasma NO contents in normal people were significantly higher than that of stroke patients, which was identified to the results reported by some scholars��?,6]. After acupuncture treatment, plasma NO level lowered significantly and the therapeutic effect of enclosing needling was superior to that of scalp-acupuncture . This may be one of the mechanisms of acupuncture-induced improvement of cerebral blood flow and clinical symptoms and signs.