Abstract: 32 cases of vascular dementia were randomly assigned to acupuncture-medicine group (16 cases) and Chinese drug group(16 cases). After treatment for two months, there was a significant difference between the two groups in the therapeutic effects (P 7 points. It was confirmed by local signs of the nervous system and examination of CT or MR on corresponding parts of brain that the patients had cerebrovascular disease and the dementia induced by other causes was excluded. Among 32 cases, 23 cases were male, 9 cases were female, aged between 58 -- 82 years old with a mean of 70 years. The course of disease was between 3 months and 5 years. They were randomly assigned to two groups, acupuncture-medicine group (16 cases ) and Chinese drug (16 cases) group.

Therapeutic methods:
In the acupuncture-medicine group, points selected were (1 ) Renzhong (GV 26 ), Sishencong (EX-HN 1 ), Shenting (GV 24 ), Benshen (GB 13 ), Zusanli (ST 36 ), Taixi (KI 3 ), Xuanzhong(GB 39 ) and (2 ) Baihui (GV 20 ), Dazhui(GV 14 ), Mingmen(GV 4 ), Ganshu (BL18), Shenshu(BL 23). 28# -- 30#, 1. 5 cun filiform needle was used and thrusting and lifting reinforcing method was adopted. The two groups of points were needled alternately. Besides the directive moxibustion with small moxa cone was used. The treatment was given once a day, 30 min each session. Fu Yuan Tang which principally consisted of Pilose Antler(Lurong), Ginseng(Renshen), Siberian Solomonseal Rhizome (Huangjing ), Wolfberry Fruit (Gouqizi), Bitter Cardamon (Yizhiren), Red Sage Root (Danshen) and so on, was administrated one dose each day. The Chinese drug group received the same medicines as that in the acupuncture-medicine group, one dose each day.

Therapeutic course: Two months constituted one therapeutic course. HDS and contents of blood SOD, LPO GSH-Px were determined respectively before treatment and after ceasing of the therapeutic course.

Detective methods: Pyrogallol auto-oxidation method was used for determination of plasma SOD; malonaldehyde thiobarbituric acid (TBA) assay for determination of plasma LPO; directive disulfide nitrobenzene(DTNB) method for determination of GSH-Px. All blood samples were taken in the early morning at fasting and detected in the experimental center of the hospital.

Observation of therapeutic effects:
Changes of intelligence and recovery of daily viability were investigated before and after treatment. Referring to the National Criteria of Assessment of Therapeutic Effects for Senile Dementia established in 1990, the therapeutic effect was divided into three grades, markedly effective, effective and ineffective. Increase of over 5 points in HDS detection was regarded as markedly effective, less than 5 points as improvement, and no change or deterioration as ineffective.

Results of treatment:
1. Improvement of intelligence
Improvement of intelligence before and after treatment was showed in the Table 1 and 2. In the two groups there were statistically significant differences before and after treatment (P <0. 01 ), and there was a significant difference (P< 0. 05 ) between the two groups. It suggests that intelligence in the patients of the two groups all increase obviously after treatment, especially, acupuncture medicine group has more remarked improvement.

2. Clinical therapeutic effects
The clinical therapeutic effects were showed in the Table 3. The markedly effective rate in the acupuncture-medicine group and the Chinese drug group was respectively 62. 5% and 31. 3 %, and the total effective rate 93. 8 % and 87. 5 %. It suggests that the therapeutic effect in the acupuncture-medicine group is higher than that in the Chinese drug group.

Table 1.Comparison before and after Treatment of HDS Accumulative Points in the Two Groups(M±SD)________________________________________________________________________

            Groups                        cases             before treatment         After treatment      P

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Acupuncture-medicine group 16                   13.50±7.58                 19.72±7.08      <0.01  

Chinese drug                          16                     14.34±7.84                 17.94±9.74     <0.01

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Table 2. Comparison between the two group in Differences of HDS Accumulative Points before and after treatment

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                                       Acupuncture-medicine group                  Chinese drug group

           Items                    Difference before and after               Difference before and after    P

                                                    treatment                                                 treatment

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            HDS

Accumulative points             6.22±3.94                                                  3.59±2.72              <0.05

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                          Table 3. Analysis of Therapeutic Effects in the Two Groups

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      Groups                    Markedly                                             Markedly           Total effective

                                     effective      Effective    Ineffective     effective                  rate

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Acu-medicine group        10                 5                  1                62.5%                     93.8%

Chinese drug group           5                 9                  2                31.3%                      87.5%

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3. Changes of Blood SOD, GSH-Px and LPO Levels
(1 ) Blood SOD, GSH-Px levels in the patient of VD were all lower than and the content of LPO was higher than normal values with significant differences as compared with the healthy persons of the same ages(P < 0. 01 ), which were showed in the Table 4.

(2) Comparisons of SOD, LPO arid GSHPx before and after treatment in the two groups.
It was showed in the Table 5 that there were significant differences (P < 0. 01 ) in the two groups in contents of SOD, LPO, GSH-Px before and after treatment, suggesting that blood contents of SOD and GSH-Px increased obviously and LPO level decreased after treatment in the patient of VD. It was indicated in the Table 6. that there were significant differences (P <0. 01, P < 0. 05 ) between the two groups in differences of SOD and GSH-Px levels before and after treatment, and there was no significant difference in LPO. It is suggested that both acupuncture and Chinese drug can increase levels of main enzymes of anti-free radical reaction, SOD, GSH-Px and decrease the main product of free radical reaction in human body, LPO. The actions were stronger for acupuncture and moxibustion combined with Chinese drug.

Table 4. Comparison between the Patient and the Healthy Person in Levels of SOD, GSH-Px, LPO (M±SD) n=32

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 Item                            Healthy persons               Patients                      P values        

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    SOD(p/mI)              39. 62 ±14. 07                 15. 61 ±7. 01                  <0. 01

    LPO(mmoI/mI)        2. 96±0. 59                       4. 89 ± 1. 86                 <0. 01

    GSH-PX(p/mI)         71.56±20.79                    33.45 ±8.21                    <0.01  

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Table 5.Comparison before and after Treatment in levels of SOD, GSH-Px and LPO in the Two Groups (M±SD) n=16

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    Items                          Acu-medicine                                          Chinese drug group

                  Before treatment    after treatment    P       Before treatment    after treatment    P

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SOD (μ/ml)     14.66±7.73            31.97±7.38    <0.01   16.53±5.82              26.68±5.64.    <0.01

LPO (mmol/ml) 5.09±2.27            3.28±1.23      <0.01     4.69±1.45             3.25±1.06       <0.01

GSH-PX(μ /ml) 30.76±12.08      60.24±28. 12    <0.01  34.44±10.31           50. 13±19.6    <0.01

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Table 6.Comparison between the Two Groups in Differences of SOD, LPO and GSH-Px Levels

Before and after Treatment(M±SD)n=16

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     Items         Acu-medicine group                 Chinese drug group                 P     

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SOD(μ /ml)        17.25±9.84                                 8. 15±6. 59                     <0.01

LPO(mmol/ml)   1.63±1.77                                  1.44±1.22                        >0.05

GSH-PX(μ /ml)  31.92±20.73                             15.38±18.14                    <0. 05

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Discussion
1. Analysis of Clinical Therapeutic Effects
Deficiency of the kidney is a basic reason of this disease. We adopted the therapeutic principle of tonifying the kidney, strengthening the brain and increasing intelligence, and selected the original acupoint of the Kidney Channel, Taixi (KI 3), influential point of marrow, Xuanzhong(GB39), and Shenshu(BL 23) for tonifying the kidney, and points of the Du Channel, Renzhong (GV 26 ), Baihui (GV 20 ), Shenting (GV 24 ), Dazhui(GV 14), Mingmen(GV 4 ) for strengthening the brain and increasing intelligence. Some studies indicate that acupuncture at Baihui point can increase memory of the human being and animals and moxibustion at Dazhui, Zusanli and other points can delay senility. Benshen and Shenting points are closely related with mind and are located at the frontal lobe. Modern medicine holds that the cerebral frontal lobe is related to intelligence, and acupuncture of them can strengthen the brain and increase intelligence. Ganshu(BL 18), Shenshu(BL 23 ) and Zusanli (ST 36) points have functions of tonifying the liver and the kidney, replenishing qi and blood. They are commonly-used points for preventing and anti-senility. Combination of these points perform commonly functions of tonifying the kidney, strengthening the brain and increasing intelligence, replenishing qi and blood, so as to improve intelligence and delay senility combination of acupuncture with Fu Yuan Tang has stronger functions of tonifying the kidney, strengthening the brain and increasing intelligence. The results in the present study indicate that disturbance of intelligence in the patient of VD can be obviously improved in both the acupuncture-medicine group and Chinese drug group and the improving action in the acupuncture-medicine group is markedly superior to that in the Chinese drug group. Especially, in the patient with disturbance of limb function, the therapeutic effect can increases obviously. It is suggested that combination of acupuncture with Chinese drug has synergistic action. Clinically, directive moxibustion with small moxa cone is more used and has better therapeutic effects.

2. Regulatory Action on Blood SOD, LPO and GSH-Px Oxygen free radical and the lipid peroxidation induced by it are one of important mechanisms causing injury of the brain. SOD and GSHPx are principal enzymes for reaction of anti-free radicals. In the series of patients, blood contents of SOD and GSH-Px were obviously lower than those and LPO level was higher than that in the healthy persons with the same ages. The results are similar to those in other studies. It indicates that inhibitory action on free radical reaction in the patient of VD decreases markedly. After treatment SOD and GSH-Px levels raise remarkedly and LPO level decreases. It suggests that the therapeutic method can increase the ability of removing free radicals in the patient of VD and inhibit free radical reaction to reduce its products and relieve injury of brain tissue caused by free radicals, so as to block or delay development of state of illness. This' is possibly one of important mechanisms for treatment of VD with the therapy. The study indicates that with improvement of blood SOD, GSH-Px and LPO levels, clinical symptoms and signs improve gradually. It suggests that combination of acupuncture with the Chinese drug for tonifying the kidney is a feasible and effective therapy for VD.

Summary
1. Combined treatment of acupuncture-moxibustion and the Chinese drug for tonifying the kidney can improve intelligence and symptoms of the patient of VD, and it is an effective therapy for VD.
2. Both acupuncture- moxibustion and the Chinese drug for tonifying the kidney have the action of removing free radicals, and their combination has a stronger action.

By Li Yanhui, Zhuang Lixing, Zheng Liang etc.