Clinical Observation on the Acupuncture-moxibustion Treatment of Vascular Dementia

ABSTRACT:
Thirty cases of vascular dementia(VD) were treated with acupuncture and moxibustion for 2 months, 9 cases were markedly effective, 18 cases effective and 3 cases ineffective. The total effective rate was 90 %. Before and after treatment, there are significant differences (P 7, they had focal signs of nervous system and were demonstrated suffering from cerebrovascular disease by the examination of CT or MRI, and the dementia induced by other causes had been excluded. All 30 cases were in-patients of the Department of Acupuncture and Moxibustion. Among them, males were 23 cases, females 7 cases; their age ranged from 54 to 84 years with an average age of 67. The course of disease was 3 months to 5 years. In the control group, there were 12 healthy subjects, half and half in both sexes, an average age was 65 years.

METHOD OF TREATMENT:
Selection of acupoints: (1 ) Renzhong (CV 26), Sishencong (EX-HN 1 ), Shenting (CV 24), Benshen(GB 13 ), Zusanli(ST 36 ), Taixi (KI 3 ) and Xuanzhong (GB 39 ). (2 ) Baihui (GV 20), Dazhui(GV 14), Mingmen(GV 4), Ganshu(BL 18) and Shenshu(BL 23). No. 28-30, 1 -1. 5 cun Filiform needle was inserted with reinforcing method of twisting and twirling, and lifting and thrusting manipulation, being sure to make patients have needling sensation. The above two groups of acupoints were used alternately. The direct moxibustion with a small moxa cone was mainly applied to the acupoints on the body and extremities, while to the acupoints on the head, acupuncture was applied principally. The treatment was given for 30 min each time, once a day. One course of treatment was composed of 2 months. HDS test was conducted and the contents of TXB2 and 6-keto-PGF1 α were determined respectively before treatment and after one course of treatment.

METHODS OF DETERMINATION
Determination of TXB2 and 6-keto-PGF1 α (which are stable metabolites of thromboxane A2(TXA2) and prostacyclin (PGIZ ) respectively. All patients and healthy subjects were not to take indomethacinum, Aspirinum, Chuanxiongqin, etc., which are the inhibitors of the symthesis of prostaglandins. The fasting venous blood were taken in the early morning. The syringes, centrifuge tubes were silicified beforehand with 5% silicon oil in xylene solution. When collecting the blood, 0. 2 ml indomethacinum-EDTA. Na2 in water solution was drawn beforehand. The specimen was centrifuged at lower temperature (4) ), 3000 xg, 15 min, the supernatent was extracted with petroleum ether and ethyl acetate, then dried by flowing. The residue remained to be determined. The kits for determination of TXB2 and 6-keto-PGF were purchased from Beijing General Hospital of Liberation Army. All samples were determined at the laboratory center of our hospital.

OBSERVATION ON EFFECTS OF TREATMENT
The changes of intelligence and the recovery of the ability of daily life of the patients were observed before and after treatment. According to the standards of therapeutic effect for senile dementia, the therapeutic results were divided into marked effect, effectiveness and ineffectiveness. And in accordance with HDS test, the scores were increased by 5 and more (including 5), it was defined as marked effect; while the scores were not increased by 5, it was defined as improvement; if the patients' condition was not changed or even exacerbated, it was ineffective.

RESULTS
1. Improvement of intelligence
There is a significant difference (P <0. 05) as compared with that in the control group, although it is slightly increased (see Table 3). The contents of plasma TXB2 and 6-keto-PGFbefore and after treatment are statistically compared with each other, there is a significant difference (P <0.05)

Table 4. Comparison of the Contests of Plasma TXB2 and 6-ketO-PGF  before and after treatment (M±SD)
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　　                            Cases                     TXB2 (pg/ml)           6-keto-PGF(pg/ml)
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Before treatment         12                        461. 54±189. 17          205. 93 ± 108. 61
After treatment             12                        354. 82±161. 11          277. 61±157. 70
　　 T                                                           3.84                              3. 31
　　 P                                                          <0.01                             <0.01
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DISCUSSION:
1. Analysis of Clinical Therapeutic Effects
It is considered in traditional Chinese medicine that vascular dementia is closely related to the kidney and brain, because the kidney dominates the bone to produce marrow, the brain is the sea of marrow which nourished by the kidney essence, if the kidney essence is insufficient, and deficiencies of both qi and blood, the brain will lose supplement, the mentality may be disturbed, then a series of manifestations of intelligence disturbance may appear in clinic. Therefore the deficiency of the kidney is the essential cause Of this disease. We formulated the therapeutic principle of tonifying the kidney and replenishing essence and strengthening the brain and replenishing essence and strengthening the brain and reinforcing the mentality. Taixi(KI 3 ) Shenshu(BL 23) and Xuanzhong(GB 39) were selected to tonify the kidney and replenish essence. Renzhong(GV 26 ), Baihui (GV 20 ), Shenting(GV 24), Dazhui(GV 26), and Mingmen (GV 4 ) were selected to strengthen the brain and reinforce the mentality. Some researchers showed that acupuncture at Baihui might raise the memory of human being and animals. And other researchers reported that moxibustion at Dazhui, Zusanli and so on could delay senility. Benshen and Shenting are closely related to mentality, acupuncture at them may increase the function of strengthening the brain and reinforcing the mentality. Ganshu, Renshu and Zusanli possess invigorating the liver and the kidney, and replenishing qi and blood. The above acupoints are used together, they can mutually play the role in tonifying the kidney and replenishing essence, strengthening the brain and reinforcing the mentality, and replenishing qi and blood, thus reaching improvement of intelligence and delay of senility. In this group, the patients were tested by HDS before treatment. The result shows the disturbance of intelligence of patients with VD are mainly marked by the decline in memory(including shortterm and remote memories) and calculative ability. After acupuncture-moxibustion treatment, the above-mentioned manifestations are all improved to a different extent, while the clinical symptoms improved in relative obviousness are of dizziness and headache, hemiparalysis or hemianesthesia, personality or emotion disturbance, forced crying and forced laughing etc.successively. It shows that acupuncture-moxibustion is a feasible and effective method for treating VD.

2. Regulating Action of Acupuncture-moxibustion on the Contents of Plasma TXB2 and
6keto-PGF1 α TXB2 and PGI2 are two humoral modulators which participate in vasomotion, the roles of them are completely opposite. TXB2 is synthesized and released by blood platelets, a strong vasoconstrictor and an agent of platelet aggregation; PGI2 is synthesized by vascular endotheliocytes, a strong vasodilator and an inhibitor of platelet aggregation. The half life periods of them are 2 -- 3 min and 30 sec at 37°c respectively. TXA2 is transformed into a stable metabolite, TXB2; while PGI2 is transformed immediately into its stable metabolite, 6-keto-PGF Therefore the contents of plasma TXB2 and 6-keto-PGFmay reflect the levels of TXA2 and PGI2 respectively in body. Under the normal condition, TXA2 and PGI2 are in dynamic equilibrium. The equilibrium of both them is an important factor to maintain the normal vasomotion and smooth blood flow. Many studies have proved that TXA2 is a strong constrictor of cerebral artery, while PGI2 may dilate the cerebral artery and markedly increase cerebral blood flow. The cerebral blood flow and the metabolism of the brain are all decreased in the patients of dementia, so the cerebral blood flow and its metabolism are the ideal indices of evaluating brain functions, and also are the reliable indices of evaluating the therapeutic effect and the prognosis of dementia. In this group of patients, the content of plasma TXB2 is obviously higher than that of the healthy subjects of the same age, while 6-keto-PGFis slightly increased as compared with that of healthy control group, but no statistical significance, suggesting that TXA2 and PGI2 in the patients of VD are in a serious imbalance condition. Because TXA2 in body is prominently increased, the cerebral arteries constrict, blood flow resistance increases, thus the blood flow in the brain is markedly reduced. After treatment of acupuncture-moxibustion, the content of plasma TXB2 is decreased, and the content of 6-keto-PGF is increased in the patients of VD. The former is decreased and the latter is increased, which might induce cerebral artery dilation, inhibit platelet aggregation, reduce the blood flow resistance, resulting in increase of cerebral blood flow. These are beneficial to the establishment of the collateral circulation and to the recovery of the cerebral functions in the focus of brain. Therefore the reconstruction of equilibrium between TXA2 and PGI2 might be one of mechanisms of the therapeutic effect of acupuncture-moxibustion treatment of VD

By Zhuang Lixing, Li Yanhui, etc.